Retinal breaks

 Retinal breaks- any full- thickness
defect in the neurosensory retina
 Can cause RD
 6% of population have break
 1/10,000-15,000 per year- RD
 0.07% chance of developing RD in a
lifetime

 Directretinal perforation, contusion,
vitreous traction
 Coup
 Contrecoup
 Usually multiple
 Inferotemporal and superonasal quadrants
 Most common- dialyses + avulsion of
vitreous base= ocular contusion
 Others: horseshoe-shaped tears,
operculated holes

 Young patients- higher incidence of eye
injury
 Rarely develop acute rhegmatogenous RD
 Vitreous acts as tamponade
 12%- immediately
 30%- 1 month
 50%- 8 months
 80%- 24 mos

 Vitreous base- 2 mm anterior and 4 mm
posterior to the ora serrata
 Optic disc, macula, along major vessels,
margins of lattice degeneration, sites of
chorioretinal scars

Increasing age- 63% in > 70 y/o
axial length
Aphakia – 66-100%
ICCE- 84%
Inflammatory disease ECCE w/ open capsule- 76%
Trauma ECCE w/ intact capsule- 40%
myopia

 Photopsias
 Multiple floaters
 Curtain or cloud
 Vitreous hemorrhage
 Retinal tear present in
 15% w/ acute PVD
 50-70% w/ acute PVD + vitreous hge

 IO w/ scleral depression
 Slit lamp biomocroscopy w/ 3- mirror
lens
 Hemorrhage or pigment?
 Reexamine in 3- 4 weeks
 patching, bed rest, head elevation for
45⁰
 B- scan
 vitrectomy

 6-10% of general population
 1/3-1/2- bilateral
 Myopia, familial predilection
1. Atrophy of the inner layers
2. Overlying pocket of liquefied vitreous,
3. condensation and adherence of vitreous at
the margin of lesion
 Progressesto RD- tractional tear or
atrophic hole

 Areas of elevated glial hyperplasia
 Noncystic retinal tufts
 Cystic retinal tufts may predispose
 Zonular traction tufts to RD

 folds of redundant retina
 Superonasally
 Associated w/ dentate processes
 Tears occur at the most posterior limit
of the folds

 Oval islands ofpars plana epithelium
located immediately posterior to the ora
 Almost/completely circumscribed by the
peripheral retina
 Tears can occur at or near the
posterrior margins of enclosed ora bays

 Paving-stone or Cobblestone
•22% over 20 y/o Degeneration
•Proliferation of RPE cells
••Atrophy approximatelyretina > 20 RD,
 RPE areas of inflammation100% trauma,y/o retinal
Old hyperplasia
•Present in of the outer and of
•Enlargement of RPE cells
•3.Atrophy of the
Temporal
 RPE hypertrophy RPE and outer retinal layers
tear
•Congenital or acquired
•4.Attenuation or absence lossthe
•1. TYPICAL may cause field of
Aging and but Cystoid Degeneration
Benign,
Peripheral the outer plexiform layer
• • •Cysts degenerative change
in
Appears as black
choriocapillaries spherical melanin granules,
•Large cells and large,
•2. RETICULAR
5.Adhesions b/n the remaining neuroepithelial
•very•dark, well demarcated
Nerve fiber layer
•BENIGN amd bruch’s membrane
layers
•Posterior to typical cystoid
•Inferior quadrant,full-retinalto the equator
•May develop into anterior break
•NEVER the site of PRIMARY retinal break

 Reduce the risk of RD
 Risk outweigh the benefit
 May not eliminate the risk of new tears
or detachment
 GOAL: create a chorioretinal scar around
the break
 Acute symptomatic break are more
dangerous than the old ones

 Acute symptomatic flap tear
 Acute operculated holes
 + persistent vitreous traction
 Large hole
 Superior location
 Vit hem
 Atrophic holes
 + traction

 Flap tears
 Emmetropic, phakic eyes
 Lattice degeneration
 Myopia
 Subclinical detachment
 Aphakia w/ detachment in the other eye
 Operculated holes
 Atrophic holes

 Treat the entire lesion
 Posterior and lateral margins
 6-10% of eyes
•High myopia
 20-30% of eyes w RD
•RD in the fellow eye
 1%- RD in untreated lattice degeneration
•flap tears
•aphakia

 1-3 % incidence of RD
 Asymptomatic breaks – prophylaxis?
 Flap tears
 Subclinical detachments

 Asymptomatic retinal detachment
 Detachment in w/c subretinal fluid
extends more than 1 DD from the break
but not more than 2DD posterior to the
equator.
 Traction on the break

TYPE OF LESION TREATMENT

Horseshoe tears Almost always

Dialysis Almost always

Operculated tear sometimes

Atrophic hole Rarely

Lattice degeneration w/o horseshoe Rarely
tears

Zorab et.al., American academy of Ophthalmology Section 12 p. 290 2008-2009

Type of lesion phakic Highly myopic Fellow eye Aphakic or
pseudophakic

Retinal Almost always Almost always Almost always Almost always
dialysis
Horseshoe sometimes sometimes sometimes sometimes
tears

Operculated no rarely rarely rarely
tears

Atrophic holes rarely rarely rarely rarely

Lattice deg’n no no sometimes rarely
w/ or w/o
holes
Zorab et.al., American academy of Ophthalmology Section 12 p. 291, 2008-2009

http://one.aao.org/CE/Practice Guidelines

Retinal breaks

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Retinal breaks